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General NPI Number Information
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NPI Number | 1518920024
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Entity Type | Organization
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Legal Business Name | EMPIRE VISION CENTER INC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 303 CLAY PITTS RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-3645
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Country | US
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Telephone | 631-754-2020
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Fax | 631-754-6259
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Provider Business Mailing Address
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Address Line | 2921 ERIE BLVD EAST
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City | SYRACUSE
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State | NY
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Zip | 13224-1430
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Country | US
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Telephone | 315-446-3145
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Fax | 315-445-7675
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Authorized Official
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Title or Position | SVP
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Name | MR. THOMAS J ROSA
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Credential |
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Telephone | 315-446-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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